腰椎结核的一期后路经椎间隙病灶清除内固定术

One-stage posterior lumbar debridement, interbody fusion, and posterior instrumentation in treating lumbar spinal tu- berculosis

目的评价椎板减压后，一期经椎间隙进行病灶清除及植骨融合内固定术对于腰椎结核治疗的可行性及疗效。方法2009年1月至2012年5月，对21例脊柱结核患者采用一期经椎间隙进行病灶清除及植骨融合内固定治疗。所有患者均为单间隙病变，累及两椎体。男14例，女7例；年龄19～47岁，平均34．8岁。L2,3椎体结核2例，L3,4椎体结核5例，L4,5椎体结核14例。所有患者均存在腰背部疼痛，7例患者伴有消瘦、低热、盗汗、乏力症状，2例患者双下肢麻木，1例患者间歇性跛行症状。21例患者术前至少经2～4周的正规抗结核治疗。术前均行腰椎X线、CT扫描及MR检查，按影像学结果拟定病椎椎弓根钉的进钉角度。结果本组病例均一期后路经椎间隙病灶清除内固定术治疗，术后结核经病理或微生物学检查确诊。手术时间平均3．1h（2．5～4．3h），出血量平均370ml（250～600m1）。21例患者均获得随访，红细胞沉降率恢复正常时间平均为术后5．8个月。术后随访时间12～48个月，平均18个月。无一例患者局部窦道形成，病灶清除术后伤口均一期愈合。脊柱结核均无复发，腰椎背部疼痛症状均明显缓解。术后随访无病灶残留及复发，无内固定松动、移位等并发症。结论在应用有效的抗结核药物前提下，对于无明显腰大肌脓肿的患者，尽可能避开病灶，灵活置入椎弓根螺钉，一期后路经椎间隙病灶清除内固定术治疗腰椎结核可以取得满意的疗效。

Objective To analyze retrospectively clinical study efficacy and feasibility of one-stage posterior lumbar de- bridement, interbody fusion, and posterior instrumentation in treating lumbar spinal tuberculosis. Methods A total of 21 pa- tients （14 males and 7 females） with lumbar tuberculosis collected from January 2009 to May 2012, underwent one-stage poste- rior lumbar debridement, interbody fusion, and posterior instrumentation. The age ranged 19 to 47 years （mean, 34.8 years）. All patients presented with presented with back pain, 7 patients with constitutional symptoms including weakness, malaise, night sweats, fever and weight loss, 2 with limbs numb and 1 with intermittence creep. Every patient underwent lumbar spine X -ray, CT scan and MRI examination of pathologic vertebra before surgery. All patients received at least a standard preoperative 2-4 week anti-tuberculosis treatment. Results All patients were confirmed by pathology or microbiology and were followed up for 12-48 months （mean, 18 months）. Average operation time was 3.1 h （range, 2.5 to 4.3 h）. Lumbar tuberculosis was completely cured and the grafted bones were fused 10 months after operation in all patients. There was no persistence or recurrence of infec- tion and no nerve, blood vessel injury. After the treatment, the erythrocyte sedimentation rate （ESR） was decreased to normal level in 5.8 months. Conclusion With effective and standard anti-tuberculosis chemotherapy, the pedicle screw was placed due to pathologic vertebral body. One-stage posterior lumbar debridement, interbody fusion, and posterior instrumentation for lumbar tu- berculosis could effectively relieve pain symptoms, and reconstruct the spinal stability.